Empathy and Compassion in Rehabilitation

Debjani Mukherjee PhD

Director Donnelley Ethics Program Shirley Ryan AbilityLab

Associate Professor Physical Medicine and Rehabilitation amp

Medical Education

Northwestern University Feinberg School of Medicine

Objectives

bull Learn the defining features of clinical empathy

bull Learn about the impact of empathy on clinical outcomes

bull Consider how empathy and emotion impact rehabilitation care

Research and clinical interests

bull Meaning-making in emotional situations - for the patient family member and Health Care provider

bull The reverberating effects of illness and injury

bull The impact of ldquotough casesrdquo and dilemmas on Health care providers

Defining Empathy

Empathy

What is empathy

What does it mean to be empathetic

Psychological and Philosophical definitions

bull Affective

bull Cognitive

bull Relational

Mehrabian A Young AL amp Sato S (1988) Emotional empathy and associated individual differences Curr Psychol Res Rev 8 221-240

What does it mean to be empatheticbull Empirical research on empathy

bull Quantitative and qualitative

bull Typically Self-report

bull No general agreement on how to define teach or study empathy(1)

bull Multidimensional

bull Key component of gaining trust and establishing rapport

1 Pederson R (2009) Empirical research on empathy in medicine ndash A critical review Patient Education and Counseling 76 307-322

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Objectives

bull Learn the defining features of clinical empathy

bull Learn about the impact of empathy on clinical outcomes

bull Consider how empathy and emotion impact rehabilitation care

Research and clinical interests

bull Meaning-making in emotional situations - for the patient family member and Health Care provider

bull The reverberating effects of illness and injury

bull The impact of ldquotough casesrdquo and dilemmas on Health care providers

Defining Empathy

Empathy

What is empathy

What does it mean to be empathetic

Psychological and Philosophical definitions

bull Affective

bull Cognitive

bull Relational

Mehrabian A Young AL amp Sato S (1988) Emotional empathy and associated individual differences Curr Psychol Res Rev 8 221-240

What does it mean to be empatheticbull Empirical research on empathy

bull Quantitative and qualitative

bull Typically Self-report

bull No general agreement on how to define teach or study empathy(1)

bull Multidimensional

bull Key component of gaining trust and establishing rapport

1 Pederson R (2009) Empirical research on empathy in medicine ndash A critical review Patient Education and Counseling 76 307-322

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Research and clinical interests

bull Meaning-making in emotional situations - for the patient family member and Health Care provider

bull The reverberating effects of illness and injury

bull The impact of ldquotough casesrdquo and dilemmas on Health care providers

Defining Empathy

Empathy

What is empathy

What does it mean to be empathetic

Psychological and Philosophical definitions

bull Affective

bull Cognitive

bull Relational

Mehrabian A Young AL amp Sato S (1988) Emotional empathy and associated individual differences Curr Psychol Res Rev 8 221-240

What does it mean to be empatheticbull Empirical research on empathy

bull Quantitative and qualitative

bull Typically Self-report

bull No general agreement on how to define teach or study empathy(1)

bull Multidimensional

bull Key component of gaining trust and establishing rapport

1 Pederson R (2009) Empirical research on empathy in medicine ndash A critical review Patient Education and Counseling 76 307-322

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Defining Empathy

Empathy

What is empathy

What does it mean to be empathetic

Psychological and Philosophical definitions

bull Affective

bull Cognitive

bull Relational

Mehrabian A Young AL amp Sato S (1988) Emotional empathy and associated individual differences Curr Psychol Res Rev 8 221-240

What does it mean to be empatheticbull Empirical research on empathy

bull Quantitative and qualitative

bull Typically Self-report

bull No general agreement on how to define teach or study empathy(1)

bull Multidimensional

bull Key component of gaining trust and establishing rapport

1 Pederson R (2009) Empirical research on empathy in medicine ndash A critical review Patient Education and Counseling 76 307-322

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Empathy

What is empathy

What does it mean to be empathetic

Psychological and Philosophical definitions

bull Affective

bull Cognitive

bull Relational

Mehrabian A Young AL amp Sato S (1988) Emotional empathy and associated individual differences Curr Psychol Res Rev 8 221-240

What does it mean to be empatheticbull Empirical research on empathy

bull Quantitative and qualitative

bull Typically Self-report

bull No general agreement on how to define teach or study empathy(1)

bull Multidimensional

bull Key component of gaining trust and establishing rapport

1 Pederson R (2009) Empirical research on empathy in medicine ndash A critical review Patient Education and Counseling 76 307-322

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

What is empathy

What does it mean to be empathetic

Psychological and Philosophical definitions

bull Affective

bull Cognitive

bull Relational

Mehrabian A Young AL amp Sato S (1988) Emotional empathy and associated individual differences Curr Psychol Res Rev 8 221-240

What does it mean to be empatheticbull Empirical research on empathy

bull Quantitative and qualitative

bull Typically Self-report

bull No general agreement on how to define teach or study empathy(1)

bull Multidimensional

bull Key component of gaining trust and establishing rapport

1 Pederson R (2009) Empirical research on empathy in medicine ndash A critical review Patient Education and Counseling 76 307-322

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

What does it mean to be empathetic

Psychological and Philosophical definitions

bull Affective

bull Cognitive

bull Relational

Mehrabian A Young AL amp Sato S (1988) Emotional empathy and associated individual differences Curr Psychol Res Rev 8 221-240

What does it mean to be empatheticbull Empirical research on empathy

bull Quantitative and qualitative

bull Typically Self-report

bull No general agreement on how to define teach or study empathy(1)

bull Multidimensional

bull Key component of gaining trust and establishing rapport

1 Pederson R (2009) Empirical research on empathy in medicine ndash A critical review Patient Education and Counseling 76 307-322

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

What does it mean to be empatheticbull Empirical research on empathy

bull Quantitative and qualitative

bull Typically Self-report

bull No general agreement on how to define teach or study empathy(1)

bull Multidimensional

bull Key component of gaining trust and establishing rapport

1 Pederson R (2009) Empirical research on empathy in medicine ndash A critical review Patient Education and Counseling 76 307-322

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Empathy

bull Empathy vs Sympathy

bull ldquohellip empathy pushes one to appreciate that another see things differently whereas sympathy may blur such differencesrdquo (pg 697)

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Clinical empathy

bull ldquoA complex affective-cognitive activity involving emotional attunement and imagining how another person feelsrdquo

bull ldquoEngaged curiosity about another personrsquos perspectiverdquo

bull ldquoTell me what I am missingrdquo

bull Halpern J Empathy and Patient-Physician Conflicts J Gen Intern Med 2007 May 22(5) 696ndash700

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Empathy vs detached concern

bull ldquoThe irony of detachment is that in seeking ldquoobjective realityrdquo physicians ignore an important source of understanding reality Through empathy physicians allow patientsrsquo suffering and emotional needs to be realhellip By allowing patients to move them emotionally physicians enable more than the physical repair of bodies they allow the healing to beginrdquo (pg 145)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Empathy and Curiosity

bull ldquoCuriosity is ongoing attentiveness and openness to what patients communicate verbally and nonverballyrdquo (pg 131)

bull Without ongoing curiosity a physician can make the mistake of thinking that the intensity of her own affective experience corresponds to the depth of her understanding of a patientrdquo (pg 132)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

How do you communicate empathy

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Communicating Empathy

bullNonverbalbull FacialbullGesturalbull Tonal

bullVerbal

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

ldquoEmpathy Bingordquo

httpspositivepsychologyprogramcomkindness-activities-empathy-worksheetsempathy

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Examplesbull A Irsquom worried about having enough money to pay my bills this month

bull B Irsquoll loan you the money

bull A Look at my scar from the cycling accident

bull B Thatrsquos nothing you should see the one on my knee

bull A I got caught in traffic for 2 hours in 100 degree weather with no air conditioning

bull B That reminds me of the timehellip

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Examples

bull A Itrsquos scary for me to get up and speak in front of people

bull B I think you should join toast masters

bull A I lost my job

bull B Cheer up letrsquos go eat

bull A I have so much to do today

bull B Are you feeling overwhelmed and want support

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

ADVISING ONE-UPPING EDUCATING

CONSOLING STORY-TELLING SHUTTING-DOWN

SYMPATHIZING INTERROGATING EXPLAINING

CORRECTING FIXING IT EMPATHIZING

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Brene Brown on Empathy RSA shorts wwwtheRSAorg)

httpswwwyoutubecomwatchv=1Evwgu369Jw

bull httpswwwthersaorgdisclaimerbull Open access licence for RSA public events content

bull Audio and video files produced by the RSA public events team are available free to view and download We allow anyone to access our content electronically without charge We want to encourage the circulation of our work as widely as possible without affecting the ownership of the copyright which remains with the copyright holder

bull RSA audio and video files are licensed under a Attribution-NonCommercial-NoDerivs 30 Unported (CC BY-NC-ND 30)

Brene Brown

bull ldquoEmpathy fuels connectionrdquo

1Perspective taking

2 Staying out of Judgment

3 Recognizing emotion in other people

4 Communicating emotion

Brene Brown

bull ldquoEmpathy is a vulnerable choicerdquo

bull ldquoWe try to lsquoput the silver liningrsquo on itrdquo

bull ldquoThe truth is rarely can a response make something better What makes something better is connectionrdquo

Research on Empathy

Measures

bull Interpersonal Reactivity Index

bull Toronto Empathy Questionnaire

bull Jefferson Empathy Scale

bull The Questionnaire of Cognitive and Affective Empathy

Measure iNTERPERSONALREACTIVITY INDEX (IRI)

Defines empathy as the ldquoreactions of one individual to the observed experiences of another (Davis 1983)rdquo

28-items answered on a 5-point Likert scale (1980 1983)

4 subscales each made up of 7 different items

bull Perspective Taking

bull Fantasy

bull Empathic Concern

bull Personal Distress

bull httpfetzerorgsitesdefaultfilesimagesstoriespdfselfmeasuresEMPATHY-InterpersonalReactivityIndexpdf

Jefferson scale of empathy

Empathy ldquolevelsrdquo

Wilson SE Prescott J Gordon Becket Empathy Levels in First- and Third-Year Students in Health and Non-Health Disciplines Am J Pharm Educ 2012 March 12 76(2) 24

Brene Brown

bull ldquoEmpathy is a vulnerable choicerdquo

bull ldquoWe try to lsquoput the silver liningrsquo on itrdquo

bull ldquoThe truth is rarely can a response make something better What makes something better is connectionrdquo

Research on Empathy

Measures

bull Interpersonal Reactivity Index

bull Toronto Empathy Questionnaire

bull Jefferson Empathy Scale

bull The Questionnaire of Cognitive and Affective Empathy

Measure iNTERPERSONALREACTIVITY INDEX (IRI)

Defines empathy as the ldquoreactions of one individual to the observed experiences of another (Davis 1983)rdquo

28-items answered on a 5-point Likert scale (1980 1983)

4 subscales each made up of 7 different items

bull Perspective Taking

bull Fantasy

bull Empathic Concern

bull Personal Distress

bull httpfetzerorgsitesdefaultfilesimagesstoriespdfselfmeasuresEMPATHY-InterpersonalReactivityIndexpdf

Jefferson scale of empathy

Empathy ldquolevelsrdquo

Wilson SE Prescott J Gordon Becket Empathy Levels in First- and Third-Year Students in Health and Non-Health Disciplines Am J Pharm Educ 2012 March 12 76(2) 24

Research on Empathy

Measures

bull Interpersonal Reactivity Index

bull Toronto Empathy Questionnaire

bull Jefferson Empathy Scale

bull The Questionnaire of Cognitive and Affective Empathy

Measure iNTERPERSONALREACTIVITY INDEX (IRI)

Defines empathy as the ldquoreactions of one individual to the observed experiences of another (Davis 1983)rdquo

28-items answered on a 5-point Likert scale (1980 1983)

4 subscales each made up of 7 different items

bull Perspective Taking

bull Fantasy

bull Empathic Concern

bull Personal Distress

bull httpfetzerorgsitesdefaultfilesimagesstoriespdfselfmeasuresEMPATHY-InterpersonalReactivityIndexpdf

Jefferson scale of empathy

Empathy ldquolevelsrdquo

Wilson SE Prescott J Gordon Becket Empathy Levels in First- and Third-Year Students in Health and Non-Health Disciplines Am J Pharm Educ 2012 March 12 76(2) 24

Measures

bull Interpersonal Reactivity Index

bull Toronto Empathy Questionnaire

bull Jefferson Empathy Scale

bull The Questionnaire of Cognitive and Affective Empathy

Measure iNTERPERSONALREACTIVITY INDEX (IRI)

Defines empathy as the ldquoreactions of one individual to the observed experiences of another (Davis 1983)rdquo

28-items answered on a 5-point Likert scale (1980 1983)

4 subscales each made up of 7 different items

bull Perspective Taking

bull Fantasy

bull Empathic Concern

bull Personal Distress

bull httpfetzerorgsitesdefaultfilesimagesstoriespdfselfmeasuresEMPATHY-InterpersonalReactivityIndexpdf

Jefferson scale of empathy

Empathy ldquolevelsrdquo

Wilson SE Prescott J Gordon Becket Empathy Levels in First- and Third-Year Students in Health and Non-Health Disciplines Am J Pharm Educ 2012 March 12 76(2) 24

Measure iNTERPERSONALREACTIVITY INDEX (IRI)

Defines empathy as the ldquoreactions of one individual to the observed experiences of another (Davis 1983)rdquo

28-items answered on a 5-point Likert scale (1980 1983)

4 subscales each made up of 7 different items

bull Perspective Taking

bull Fantasy

bull Empathic Concern

bull Personal Distress

bull httpfetzerorgsitesdefaultfilesimagesstoriespdfselfmeasuresEMPATHY-InterpersonalReactivityIndexpdf

Jefferson scale of empathy

Empathy ldquolevelsrdquo

Wilson SE Prescott J Gordon Becket Empathy Levels in First- and Third-Year Students in Health and Non-Health Disciplines Am J Pharm Educ 2012 March 12 76(2) 24

Jefferson scale of empathy

Empathy ldquolevelsrdquo

Wilson SE Prescott J Gordon Becket Empathy Levels in First- and Third-Year Students in Health and Non-Health Disciplines Am J Pharm Educ 2012 March 12 76(2) 24

Empathy ldquolevelsrdquo

Wilson SE Prescott J Gordon Becket Empathy Levels in First- and Third-Year Students in Health and Non-Health Disciplines Am J Pharm Educ 2012 March 12 76(2) 24

Empathy and outcomesAcad Med 2011 Mar86(3)359-64

Physicians empathy and clinical outcomes for diabetic patients

Hojat M Louis DZ Markham FW Wender R Rabinowitz C Gonnella JS

Acad Med 2012 Sep87(9)1243-9

The relationship between physician empathy and disease

complications an empirical study of primary care

physicians and their diabetic patients in Parma Italy

Del Canale S Louis DZ Maio V Wang X Rossi G Hojat M Gonnella JS

Empathy and competence

Bayne H et al A comprehensive model for optimizing empathy in person-centered care

Patient Educ Couns (2013) httpdxdoiorg101016jpec201305016

Internal Barriers

ldquo And I suppose thatrsquos what physicians do you know just come in and say you have cancer and walk out and you donrsquot have to deal with your own emotions And so it may not behellip that theyrsquore not empathetic they just donrsquot want to be too vulnerable You know because as soon as you open yourself up you starthellip becoming too involved with patientsrdquo (H Bayne et al 2013)

External barriers

bull ldquoI think unfortunately what medicinersquos turned to nowadays is itrsquos less about what the patientrsquos feeling and more about what the insurance company telling me I have to do what I gotta give and how Irsquom getting out of here by such and such hourrdquo

Patient role

bull ldquoYeah some people arenrsquot very nice You know Some people who come in theyrsquore kind of endearinghellip And some people are just horribly mean And they were mean to start with and now you put them in a bad situation and now you put them in a bad situation and they become downright brutal And there are just some people you donrsquot want to go and deal with and just very very short because you donrsquot feel like taking their abuserdquo

Compassion

Compassion

Related conceptsbull EmpathybullKindnessbullAltruismbullCarebullPity

Compassion

Five elements1 Recognizing suffering2 Understanding the universality of human suffering3 Feeling for the person suffering4 Tolerating uncomfortable feelings5 Motivation to actacting to alleviate suffering

Strauss C1 Lever Taylor B2 Gu J3 Kuyken W4 Baer R5 Jones F6 Cavanagh K3What is compassion

and how can we measure it A review of definitions and measures

Clin Psychol Rev 2016 Jul4715-27

Bayne H et al A comprehensive model for optimizing empathy in person-centered care

Patient Educ Couns (2013) httpdxdoiorg101016jpec201305016

Internal Barriers

ldquo And I suppose thatrsquos what physicians do you know just come in and say you have cancer and walk out and you donrsquot have to deal with your own emotions And so it may not behellip that theyrsquore not empathetic they just donrsquot want to be too vulnerable You know because as soon as you open yourself up you starthellip becoming too involved with patientsrdquo (H Bayne et al 2013)

External barriers

bull ldquoI think unfortunately what medicinersquos turned to nowadays is itrsquos less about what the patientrsquos feeling and more about what the insurance company telling me I have to do what I gotta give and how Irsquom getting out of here by such and such hourrdquo

Patient role

bull ldquoYeah some people arenrsquot very nice You know Some people who come in theyrsquore kind of endearinghellip And some people are just horribly mean And they were mean to start with and now you put them in a bad situation and now you put them in a bad situation and they become downright brutal And there are just some people you donrsquot want to go and deal with and just very very short because you donrsquot feel like taking their abuserdquo

Compassion

Compassion

Related conceptsbull EmpathybullKindnessbullAltruismbullCarebullPity

Compassion

Five elements1 Recognizing suffering2 Understanding the universality of human suffering3 Feeling for the person suffering4 Tolerating uncomfortable feelings5 Motivation to actacting to alleviate suffering

Strauss C1 Lever Taylor B2 Gu J3 Kuyken W4 Baer R5 Jones F6 Cavanagh K3What is compassion

and how can we measure it A review of definitions and measures

Clin Psychol Rev 2016 Jul4715-27

Internal Barriers

ldquo And I suppose thatrsquos what physicians do you know just come in and say you have cancer and walk out and you donrsquot have to deal with your own emotions And so it may not behellip that theyrsquore not empathetic they just donrsquot want to be too vulnerable You know because as soon as you open yourself up you starthellip becoming too involved with patientsrdquo (H Bayne et al 2013)

External barriers

bull ldquoI think unfortunately what medicinersquos turned to nowadays is itrsquos less about what the patientrsquos feeling and more about what the insurance company telling me I have to do what I gotta give and how Irsquom getting out of here by such and such hourrdquo

Patient role

bull ldquoYeah some people arenrsquot very nice You know Some people who come in theyrsquore kind of endearinghellip And some people are just horribly mean And they were mean to start with and now you put them in a bad situation and now you put them in a bad situation and they become downright brutal And there are just some people you donrsquot want to go and deal with and just very very short because you donrsquot feel like taking their abuserdquo

Compassion

Compassion

Related conceptsbull EmpathybullKindnessbullAltruismbullCarebullPity

Compassion

Five elements1 Recognizing suffering2 Understanding the universality of human suffering3 Feeling for the person suffering4 Tolerating uncomfortable feelings5 Motivation to actacting to alleviate suffering

Strauss C1 Lever Taylor B2 Gu J3 Kuyken W4 Baer R5 Jones F6 Cavanagh K3What is compassion

and how can we measure it A review of definitions and measures

Clin Psychol Rev 2016 Jul4715-27

External barriers

bull ldquoI think unfortunately what medicinersquos turned to nowadays is itrsquos less about what the patientrsquos feeling and more about what the insurance company telling me I have to do what I gotta give and how Irsquom getting out of here by such and such hourrdquo

Patient role

bull ldquoYeah some people arenrsquot very nice You know Some people who come in theyrsquore kind of endearinghellip And some people are just horribly mean And they were mean to start with and now you put them in a bad situation and now you put them in a bad situation and they become downright brutal And there are just some people you donrsquot want to go and deal with and just very very short because you donrsquot feel like taking their abuserdquo

Compassion

Compassion

Related conceptsbull EmpathybullKindnessbullAltruismbullCarebullPity

Compassion

Five elements1 Recognizing suffering2 Understanding the universality of human suffering3 Feeling for the person suffering4 Tolerating uncomfortable feelings5 Motivation to actacting to alleviate suffering

Strauss C1 Lever Taylor B2 Gu J3 Kuyken W4 Baer R5 Jones F6 Cavanagh K3What is compassion

and how can we measure it A review of definitions and measures

Clin Psychol Rev 2016 Jul4715-27

Patient role

bull ldquoYeah some people arenrsquot very nice You know Some people who come in theyrsquore kind of endearinghellip And some people are just horribly mean And they were mean to start with and now you put them in a bad situation and now you put them in a bad situation and they become downright brutal And there are just some people you donrsquot want to go and deal with and just very very short because you donrsquot feel like taking their abuserdquo

Compassion

Compassion

Related conceptsbull EmpathybullKindnessbullAltruismbullCarebullPity

Compassion

Five elements1 Recognizing suffering2 Understanding the universality of human suffering3 Feeling for the person suffering4 Tolerating uncomfortable feelings5 Motivation to actacting to alleviate suffering

Strauss C1 Lever Taylor B2 Gu J3 Kuyken W4 Baer R5 Jones F6 Cavanagh K3What is compassion

and how can we measure it A review of definitions and measures

Clin Psychol Rev 2016 Jul4715-27

Compassion

Compassion

Related conceptsbull EmpathybullKindnessbullAltruismbullCarebullPity

Compassion

Five elements1 Recognizing suffering2 Understanding the universality of human suffering3 Feeling for the person suffering4 Tolerating uncomfortable feelings5 Motivation to actacting to alleviate suffering

Strauss C1 Lever Taylor B2 Gu J3 Kuyken W4 Baer R5 Jones F6 Cavanagh K3What is compassion

and how can we measure it A review of definitions and measures

Clin Psychol Rev 2016 Jul4715-27

Compassion

Related conceptsbull EmpathybullKindnessbullAltruismbullCarebullPity

Compassion

Five elements1 Recognizing suffering2 Understanding the universality of human suffering3 Feeling for the person suffering4 Tolerating uncomfortable feelings5 Motivation to actacting to alleviate suffering

Strauss C1 Lever Taylor B2 Gu J3 Kuyken W4 Baer R5 Jones F6 Cavanagh K3What is compassion

and how can we measure it A review of definitions and measures

Clin Psychol Rev 2016 Jul4715-27

Compassion

Five elements1 Recognizing suffering2 Understanding the universality of human suffering3 Feeling for the person suffering4 Tolerating uncomfortable feelings5 Motivation to actacting to alleviate suffering

Strauss C1 Lever Taylor B2 Gu J3 Kuyken W4 Baer R5 Jones F6 Cavanagh K3What is compassion

and how can we measure it A review of definitions and measures

Clin Psychol Rev 2016 Jul4715-27

Compassionate Healthcare

bull The Schwartz Center for Compassionate Healthcare

bull httpwwwtheschwartzcenterorg

bull BOSTON (June 27 2017)mdashThe Schwartz Center for Compassionate Healthcare a national leader in the movement to strengthen and sustain the human connection at the heart of healthcare today announced the results from a national poll of patients physicians and nurses that indicated that while patients feel more positively about the US healthcare system today than in 2010 theyrsquore concerned as are physicians and nurses about the future of compassion

Compassion

Definition of compassion

sympathetic consciousness of others distress together with a desire to alleviate it

bull httpswwwmerriam-webstercomdictionarycompassion

Emotion and Cognition

Emotions in Medicine

bull ldquoThe doctor-patient [clinician-patient] interaction is fundamentally a human connection and emotions are a de facto part of itrdquo (pg 210)

Offri D (2013) What Doctors Feel How Emotions AffectThe Practice of Medicine Beacon Press

bull ldquoIn general empathy is easier the more we can identify with someone When we can genuinely envision ourselves in a situation itrsquos possible to intuit what that personrsquos suffering might feel like When the gap between doctor and patient is larger ndash for whatever reason ndash the challenge is thornierrdquo (Ofri pg 16)

Emotion

bull ldquoEmotion A complex pattern of changes including physiological arousal feelings cognitive processes and behavioral reactions made in response to a situation perceived to be personally significantrdquo

bull American Psychological Association Glossary of Terms httpwwwapaorgresearchactionglossaryaspxtab=5

Emotion Plutchiks wheel

httpenwikipediaorgwikiContrasting_and_categorization_of_emotions

Emotions

Atlas of Emotions

bull httpatlasofemotionsorgcontinents

Emotional Space ndash Distance and Connection

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Emotion and Cognition

Emotions in Medicine

bull ldquoThe doctor-patient [clinician-patient] interaction is fundamentally a human connection and emotions are a de facto part of itrdquo (pg 210)

Offri D (2013) What Doctors Feel How Emotions AffectThe Practice of Medicine Beacon Press

bull ldquoIn general empathy is easier the more we can identify with someone When we can genuinely envision ourselves in a situation itrsquos possible to intuit what that personrsquos suffering might feel like When the gap between doctor and patient is larger ndash for whatever reason ndash the challenge is thornierrdquo (Ofri pg 16)

Emotion

bull ldquoEmotion A complex pattern of changes including physiological arousal feelings cognitive processes and behavioral reactions made in response to a situation perceived to be personally significantrdquo

bull American Psychological Association Glossary of Terms httpwwwapaorgresearchactionglossaryaspxtab=5

Emotion Plutchiks wheel

httpenwikipediaorgwikiContrasting_and_categorization_of_emotions

Emotions

Atlas of Emotions

bull httpatlasofemotionsorgcontinents

Emotional Space ndash Distance and Connection

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Emotions in Medicine

bull ldquoThe doctor-patient [clinician-patient] interaction is fundamentally a human connection and emotions are a de facto part of itrdquo (pg 210)

Offri D (2013) What Doctors Feel How Emotions AffectThe Practice of Medicine Beacon Press

bull ldquoIn general empathy is easier the more we can identify with someone When we can genuinely envision ourselves in a situation itrsquos possible to intuit what that personrsquos suffering might feel like When the gap between doctor and patient is larger ndash for whatever reason ndash the challenge is thornierrdquo (Ofri pg 16)

Emotion

bull ldquoEmotion A complex pattern of changes including physiological arousal feelings cognitive processes and behavioral reactions made in response to a situation perceived to be personally significantrdquo

bull American Psychological Association Glossary of Terms httpwwwapaorgresearchactionglossaryaspxtab=5

Emotion Plutchiks wheel

httpenwikipediaorgwikiContrasting_and_categorization_of_emotions

Emotions

Atlas of Emotions

bull httpatlasofemotionsorgcontinents

Emotional Space ndash Distance and Connection

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

bull ldquoIn general empathy is easier the more we can identify with someone When we can genuinely envision ourselves in a situation itrsquos possible to intuit what that personrsquos suffering might feel like When the gap between doctor and patient is larger ndash for whatever reason ndash the challenge is thornierrdquo (Ofri pg 16)

Emotion

bull ldquoEmotion A complex pattern of changes including physiological arousal feelings cognitive processes and behavioral reactions made in response to a situation perceived to be personally significantrdquo

bull American Psychological Association Glossary of Terms httpwwwapaorgresearchactionglossaryaspxtab=5

Emotion Plutchiks wheel

httpenwikipediaorgwikiContrasting_and_categorization_of_emotions

Emotions

Atlas of Emotions

bull httpatlasofemotionsorgcontinents

Emotional Space ndash Distance and Connection

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Emotion

bull ldquoEmotion A complex pattern of changes including physiological arousal feelings cognitive processes and behavioral reactions made in response to a situation perceived to be personally significantrdquo

bull American Psychological Association Glossary of Terms httpwwwapaorgresearchactionglossaryaspxtab=5

Emotion Plutchiks wheel

httpenwikipediaorgwikiContrasting_and_categorization_of_emotions

Emotions

Atlas of Emotions

bull httpatlasofemotionsorgcontinents

Emotional Space ndash Distance and Connection

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Emotion Plutchiks wheel

httpenwikipediaorgwikiContrasting_and_categorization_of_emotions

Emotions

Atlas of Emotions

bull httpatlasofemotionsorgcontinents

Emotional Space ndash Distance and Connection

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Emotions

Atlas of Emotions

bull httpatlasofemotionsorgcontinents

Emotional Space ndash Distance and Connection

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Emotional Space ndash Distance and Connection

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Cognitive Biases

bull Streamline Information-processing

bull Impact human judgement

bull Affect decision-making

bull ldquoSystematic errors highlight the psychological processes that underlie perception and judgementrdquo (Tversky amp Kahneman1999)

46

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Confirmation Bias

47

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Confirmation Bias

bull Favoring of information that confirms beliefs or hypotheses

bull Interpreting ambiguous evidence as supportive of belief

bull Attending to information selectively

bull Remembering information selectively

bull Effect is stronger for deeply held beliefs

bull Effect is stronger for emotionally laden topics

48

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Fundamental Attribution Error

bull Perceive

bull Judge

bull Attribute

bull We believe our own actions are situational or based on context

bull We believe others actions are dispositional or based on personality or character or more stable aspects

49

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Contact Bias

bull Healthcare providers interact with patients when they are physically and often emotionally vulnerable

bull The full context of the personrsquos life is not as obvious as is the list of problems difficulties and ailments

bull May be impacted by lsquoanchoringrsquo or the use of an initial piece of information to make subsequent judgments

bull This contact bias reifies notions of patienthood50

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Asch Distracted by Disability

51

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Asch Distracted by Disability

ldquoThe bioethics and medical literatures have not fully absorbed the reports of people with disabilities or of social researchers indicating that the majority of disabled people consider their lives somewhat or very satisfyingrdquo (Asch 1998 pg 79)

52

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Challenges in Rehabilitation

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Aspects to consider

bullAbleism

bullProjection

bullDisability Culture

bullDiversity

bull Inspiration

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Ableism

Definition of ABLEISMbull discrimination or prejudice against individuals with

disabilities bull mdash ablemiddotist adjectivebull First Known Use of ABLEISMbull 1981

bull httpwwwmerriam-webstercomdictionaryableism

55

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Empathy is not projection bull Golden Rule thinking and Disability

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

57

Clash of Cultures

Longmore PK (1995) Medical Decision Making and People with Disabilities A Clash of Cultures Journal of Law Medicine amp Ethics 2382-87

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Background Disability Studies

bull An interdisciplinary field with intellectual roots in the social sciences humanities amp rehabilitation sciences

bull The power of explanatory models is great

58

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Medical Model

bullDisability is negative or pathological

bullDisability resides within the patient

bullSolution for disability-related problems is

cure

bullExpert is the health care professional

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Social Model

bullDisability is a difference

bullDisability resides in the interaction

between the person and Society

bullSolution is to change the relationship

between the person and society

bullExpert can be the person an

advocate or anyone who changes the

relationship

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Diversity

bull ldquoTheir disabilities varied so widely that that it was difficult ndasheven deceptive ndash to generalize about such womenhelliprdquo (pg 127)

61

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Disability as Inspiration

bull httpswwwyoutubecomwatchv=8K9Gg164Bsw

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Implications for Ethics

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Core Principles of Biomedical Ethics

bull Beneficence

bull Respect for Autonomy

bull Nonmaleficence

bull Justice

Beauchamp TL Childress JF Principles of Biomedical Ethics 7th ed New

York Oxford University Press 2013

64

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

EthicsVarious theories and frameworks can be used to

analyze ethical considerations including a focus on

bull Principles

bull Relationships

bull Virtues

bull Consequences

bull Rules

bull Process

bull Mukherjee D (2011) Ethical Considerations In Zollman F (ed) Management of Traumatic Brain Injury

65

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Care EthicsEthics of Care

bull Relational

bull Dependence and Interdependence

bull Contextual features

bull Often associated with feminist ethicsbull Theorists include Carol Gilligan Ned Noddings Eva Feder Kittay

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Substituted judgment

Surrogate decision-makers

are instructed to make decisions

as heshe believe

the patient would if they could

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Substituted Judgment

bull Perspective of the Decision-maker

bull Egocentric

bull Simulated

bull Projected

bull Benevolent

bull Tunney RJ amp Ziegler FV (2015) Toward a Psychology of Surrogate Decision Making Perspectives on Psychological Science Vol 10 (6)880-885

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Substituted Judgment

bull ldquoThree separate but related lines of research show the weaknesses of substituted judgmentrdquo

bull Preferences change over timebull Accuracy of surrogate decisionsbull Patients want input from family and clinicians

(Torke Alexander amp Lantos 2008)

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Best Interests

In the absence of known wishes

a best interests criterion is used

ie the decision-maker makes a decision

in the best interest of the patient

weighing the benefits and burdens of treatment

in light of the patientrsquos condition

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

ldquoDefining the Good Life Following Acquired Physical Disabilityrdquo

Dunn DS amp Brody C Defining the good life following acquired physical disability Rehabilitation Psychology Vol 53(4) Nov 2008 413-425

71

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Various Terms

bull Life satisfaction ndash overall belief that onersquos life is a good one

bull Quality of life ndash a summary index of expectations evaluations emotions and achievements factoring into the good life

bull Subjective well being ndash an overall assessment that onersquos life is good coupled with relatively high levels of ongoing positive affect and correspondingly low levels of negative affect

bull Happiness ndash a shorthand for these other constructs which overlap with one another conceptually and empirically

72

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Limited predictive power of many variables

No or low correlation

- Income

- Education

- Social Class

- Intelligence

- Age

- Gender

- Physical Attractiveness

- Raceethnicity

- Offspring

- Climate

73

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Impact on Clinicians

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Related Concepts in the literature

bull Compassion Fatiguebull Burnoutbull Moral Distressbull Vicarious Traumatizationbull Secondary Traumatic Stress

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Measure Professional Quality of Life scale

The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma The ProQOL has sub-scales for compassion satisfaction burnout and compassion fatiguehttpproqolorguploadsProQOL_5_Englishpdf

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Measure Professional Quality of Life scale

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Moral Distress

bull The stress experienced when there is a conflict between the individualrsquos values and the situation in which they find themselves

bull ldquoTraditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels shehe is not able to preserve all interests and values at stakerdquo

bull Kalvemark S Hoglund AT Hansson MG Westerholm P Arnetz B Living with conflicts-ethical dilemmas and moral distress in the health care system Soc Sci Med 2004541075-1084

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Moral distress

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Clinical Decision-making Goal-setting

ldquoA patient had significant swallowing problems and was unable to eat Despite continuous family education they continued to give him food and would becomeupset when he would chokerdquo

ldquoA seeming attempt to discourage hope in the name of realistic acceptance of disability Acute rehab is too early to have a definitive answer to long-term outcomesrdquo

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Compassion Fatigue

feeling overwhelmed by a patients suffering and caring for patients until the professional is ldquodrained of empathyrdquo

ldquoCompassion fatigue may be emotionally devastating for caregivers particularly since incidents that trigger the phenomenon are unavoidable and most individuals have difficulty recognizing their own compassion fatiguerdquo

Udipi S Veach PM Kao J amp LeRoy B (2008) The Psychic Costs of Empathic Engagement Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue J Genet Counsel 17 459-471

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Burnout and Vicarious Traumatization

bull ldquoVicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain fear and terror that trauma survivors have enduredrdquo

bull American Counseling Association

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

What strategies do you use to stay engaged empathetic and compassionate

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Interventions

bull Mindfulness

bull Self-compassion

bull Self-care

bull Social connectedness

bull Diversifying coping strategies

bull Narrative Medicine

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Mindfulness

ldquoMindfulness means paying attention in a particular way

on purpose in the present moment and nonjudgmentallyrdquo

bull Kabat Zinn J (1994) Wherever You Go There You Are Mindfulness Meditation in Everday Life New York MJF Books

85

Mindfulness

bull ldquoIn our habits we become automatons ndash at times unaware unfeeling and distracted These habits lead to the loss of presence the loss of awareness and the development of routine interaction and interpersonal responsesrdquo

Connelly JE (2005) Narrative Possibilities using mindfulness in clinical practice Perspectives in Biology and Medicine Vol 48 No 1 pg 84-94

Mindfulness

bull ldquoBy developing such awareness physicians can experience a sense of the transformation of the sense of self Feelings of spaciousness including ease patience trust and compassion may arise This personal space may enable true caring for the patient or the capacity to ldquobe withrdquo the patientrsquos situation or even patience ndash the enduring of pain or trouble with calmness and composurerdquo (p 87)

bull Connelly JE (2005) Narrative Possibilities using mindfulness in clinical practice Perspectives in Biology and Medicine Vol 48 No 1 pg 84-94

Self- compassion

ldquohellipSelf-compassion involves treating yourself with care and concern when considering personal inadequacies mistakes failures and painful life situationsrdquo

Smeets E Neff K Alberts H amp Peters M (2014) Meeting Suffering With Kindness Effects of a Brief Self-Compassion Intervention for Female College Students Journal of Clinical PsychologyVol xx(x) 1ndash15

Self-Compassion

ldquoIt comprises three interacting components

bull Self-kindness versus self-judgment

bull Sense of common humanity versus isolation

bull Mindfulness versus over-identificationrdquo

bull Smeets E Neff K Alberts H amp Peters M (2014) Meeting Suffering With Kindness Effects of a Brief Self-Compassion Intervention for Female College Students Journal of Clinical PsychologyVol xx(x) 1ndash15

Summary

bull Empathy

bullCompassion

bull Emotion amp Cognition

bullChallenges in Rehabilitation

bull Implications for Ethics

bull Impact on Clinicians

Mindfulness

bull ldquoBy developing such awareness physicians can experience a sense of the transformation of the sense of self Feelings of spaciousness including ease patience trust and compassion may arise This personal space may enable true caring for the patient or the capacity to ldquobe withrdquo the patientrsquos situation or even patience ndash the enduring of pain or trouble with calmness and composurerdquo (p 87)

bull Connelly JE (2005) Narrative Possibilities using mindfulness in clinical practice Perspectives in Biology and Medicine Vol 48 No 1 pg 84-94

Self- compassion

ldquohellipSelf-compassion involves treating yourself with care and concern when considering personal inadequacies mistakes failures and painful life situationsrdquo

Smeets E Neff K Alberts H amp Peters M (2014) Meeting Suffering With Kindness Effects of a Brief Self-Compassion Intervention for Female College Students Journal of Clinical PsychologyVol xx(x) 1ndash15

Self-Compassion

ldquoIt comprises three interacting components

bull Self-kindness versus self-judgment

bull Sense of common humanity versus isolation

bull Mindfulness versus over-identificationrdquo

bull Smeets E Neff K Alberts H amp Peters M (2014) Meeting Suffering With Kindness Effects of a Brief Self-Compassion Intervention for Female College Students Journal of Clinical PsychologyVol xx(x) 1ndash15

Summary

bull Empathy

bullCompassion

bull Emotion amp Cognition

bullChallenges in Rehabilitation

bull Implications for Ethics

bull Impact on Clinicians

Self- compassion

ldquohellipSelf-compassion involves treating yourself with care and concern when considering personal inadequacies mistakes failures and painful life situationsrdquo

Smeets E Neff K Alberts H amp Peters M (2014) Meeting Suffering With Kindness Effects of a Brief Self-Compassion Intervention for Female College Students Journal of Clinical PsychologyVol xx(x) 1ndash15

Self-Compassion

ldquoIt comprises three interacting components

bull Self-kindness versus self-judgment

bull Sense of common humanity versus isolation

bull Mindfulness versus over-identificationrdquo

bull Smeets E Neff K Alberts H amp Peters M (2014) Meeting Suffering With Kindness Effects of a Brief Self-Compassion Intervention for Female College Students Journal of Clinical PsychologyVol xx(x) 1ndash15

Summary

bull Empathy

bullCompassion

bull Emotion amp Cognition

bullChallenges in Rehabilitation

bull Implications for Ethics

bull Impact on Clinicians

Self-Compassion

ldquoIt comprises three interacting components

bull Self-kindness versus self-judgment

bull Sense of common humanity versus isolation

bull Mindfulness versus over-identificationrdquo

bull Smeets E Neff K Alberts H amp Peters M (2014) Meeting Suffering With Kindness Effects of a Brief Self-Compassion Intervention for Female College Students Journal of Clinical PsychologyVol xx(x) 1ndash15

Summary

bull Empathy

bullCompassion

bull Emotion amp Cognition

bullChallenges in Rehabilitation

bull Implications for Ethics

bull Impact on Clinicians

Summary

bull Empathy

bullCompassion

bull Emotion amp Cognition

bullChallenges in Rehabilitation

bull Implications for Ethics

bull Impact on Clinicians